Comparisons of Cognitive Stimulation Therapy Between Community Versus Hospital-Based Settings: A Multi-Site Study.

BACKGROUND: Non-pharmacological interventions such as Cognitive Stimulation Therapy (CST) have been shown to help persons living with dementia in improving cognitive function and recall. While previous CST interventions have been conducted largely with community populations, none have explored the outcomes of CST in larger healthcare settings. Our study explored differences of cognitive function, mood, and quality-of-life from CST groups both community and residential-based groups. METHOD: Participants (N = 258) from academic and rural, hospital-based settings in Missouri engaged in 14-session psychosocial groups to aid reminiscence for enhanced cognitive function and recall. RESULTS: Post-intervention cognitive function improvements occurred for community (t = -7.48, p < .001) and residential samples (t = -2.46, p < .05). Community groups showed significant improvement in overall mood related to their dementia (t = 6.37, p < .001). CONCLUSION: Healthcare providers should consider CST as a supplemental intervention for older patients receiving usual care for dementia-related symptoms.

Cross-Modal Somatosensory Repetition Priming and Speech Processing.

BACKGROUND: Motor speech treatment approaches have been applied in both adults with aphasia and apraxia of speech and children with speech-sound disorders. Identifying links between motor speech intervention techniques and the modes of action (MoA) targeted would improve our understanding of how and why motor speech interventions achieve their effects, along with identifying its effective components. The current study focuses on identifying potential MoAs for a specific motor speech intervention technique. OBJECTIVES: We aim to demonstrate that somatosensory inputs can influence lexical processing, thus providing further evidence that linguistic information stored in the brain and accessed as part of speech perception processes encodes information related to speech production. METHODS: In a cross-modal repetition priming paradigm, we examined whether the processing of external somatosensory priming cues was modulated by both word-level (lexical frequency, low- or high-frequency) and speech sound articulatory features. The study participants were divided into two groups. The first group consisted of twenty-three native English speakers who received somatosensory priming stimulation to their oro-facial structures (either to labial corners or under the jaw). The second group consisted of ten native English speakers who participated in a control study where somatosensory priming stimulation was applied to their right or left forehead as a control condition. RESULTS: The results showed significant somatosensory priming effects for the low-frequency words, where the congruent somatosensory condition yielded significantly shorter reaction times and numerically higher phoneme accuracy scores when compared to the incongruent somatosensory condition. Data from the control study did not reveal any systematic priming effects from forehead stimulation (non-speech related site), other than a general (and expected) tendency for longer reaction times with low-frequency words. CONCLUSIONS: These findings provide further support for the notion that speech production information is represented in the mental lexicon and can be accessed through exogenous Speech-Language Pathologist driven somatosensory inputs related to place of articulation.

Development and Validation of a Probe Word List to Assess Speech Motor Skills in Children.

Purpose The aim of the study was to develop and validate a probe word list and scoring system to assess speech motor skills in preschool and school-age children with motor speech disorders. Method This article describes the development of a probe word list and scoring system using a modified word complexity measure and principles based on the hierarchical development of speech motor control known as the Motor Speech Hierarchy (MSH). The probe word list development accounted for factors related to word (i.e., motoric) complexity, linguistic variables, and content familiarity. The probe word list and scoring system was administered to 48 preschool and school-age children with moderate-to-severe speech motor delay at clinical centers in Ontario, Canada, and then evaluated for reliability and validity. Results One-way analyses of variance revealed that the motor complexity of the probe words increased significantly for each MSH stage, while no significant differences in the linguistic complexity were found for neighborhood density, mean biphone frequency, or log word frequency. The probe word list and scoring system yielded high reliability on measures of internal consistency and intrarater reliability. Interrater reliability indicated moderate agreement across the MSH stages, with the exception of MSH Stage V, which yielded substantial agreement. The probe word list and scoring system demonstrated high content, construct (unidimensionality, convergent validity, and discriminant validity), and criterion-related (concurrent and predictive) validity. Conclusions The probe word list and scoring system described in the current study provide a standardized method that speech-language pathologists can use in the assessment of speech motor control. It can support clinicians in identifying speech motor difficulties in preschool and school-age children, set appropriate goals, and potentially measure changes in these goals across time and/or after intervention.

An Age-Friendly Health System.

BACKGROUND/OBJECTIVES: To describe a screening and intervention program for geriatric syndromes instituted at a rural healthcare system that utilizes the 4Ms of an age-friendly health system, and to provide exercise and cognitive stimulation therapy (CST) as part of an age-friendly health program. DESIGN: Retrospective evaluation of clinical data. SETTING: Rural primary healthcare system. PARTICIPANTS: Older adults aged 65 years and older in Perry County, Missouri. MEASUREMENTS: Screening for geriatric syndromes was done using the Rapid Geriatric Assessment (RGA), which includes the FRAIL, SARC-F, Simplified Nutritional Appetite Questionnaire (SNAQ), and Rapid Cognitive Screen (RCS). Outcomes for exercise and CST included the Five Times Sit to Stand (FTSS) and Timed Up and Go (TUG) tests, Cornell Scale for Depression in Dementia (CSDD), Saint Louis University Mental Status Examination (SLUMS), and Quality of Life in Alzheimer's Disease (QoL-AD) measures. RESULTS: The RGA was administered to 1,326 individuals of which 36.5% were frail, 42.1% were sarcopenic, 26.1% were at risk for anorexia, and 20.8% had dementia. Of these receiving exercise therapy, both the FTSS and the TUG were improved at 3 months and 12 to 24 months. In the CST group, SLUMS, QoL-AD, and CSDD were improved at 7 weeks and 6 to 12 months. CONCLUSION: It is feasible to introduce a screening program for geriatric syndromes and respond to the results with successful exercise and cognitive stimulation therapy programs.

Measuring and Training Speech-Language Pathologists' Orofacial Cueing: A Pilot Demonstration.

Tactile-kinesthetic-proprioceptive (TKP) input used to facilitate speech motor control is considered an active ingredient within speech motor interventions. Objective metrics identifying skill level differences across speech-language pathologists (S-LP) providing TKP cues are crucial for monitoring treatment delivery fidelity. The study examined three kinematic measures indicating accuracy and consistency of TKP inputs by 3 S-LPs with varying experience levels (S-LP 1: novice; S-LP 2 and S-LP 3: advanced). Confidence interval measures were used to compare the accuracy of jaw movement amplitudes of the vowel /a/ made by a model participant versus S-LPs giving the TKP input. Generalised Orthogonal Procrustes Analysis (GPA) and cyclic Spatial Temporal Index (cSTI) were used to determine movement consistency. Results revealed passive jaw excursions induced by S-LP 2 and 3 to be not statistically significant from the model participant's active jaw movements. cSTI values decreased with advanced level of experience (19.28, 12.14, and 9.33 for S-LP 1, S-LP 2, and S-LP 3, respectively). GPA analyses revealed a similar pattern for S-LPs with more experience demonstrating lower mean RMS values (0.22, 0.03, and 0.11 for S-LP 1, S-LP 2, and S-LP 3, respectively). Findings suggest kinematic measures adapted from the motor control literature can be applied to assess S-LP skill differences in providing TKP cues.

Making a Difference: A Study of Cognitive Stimulation Therapy for Persons with Dementia.

Affecting nearly 5.4 million older adults in the United States and 35.6 million individuals worldwide, dementia is one of the greatest public health crises of our time. As a result, helping professionals, clients, and care partners seek effective and affordable treatment. Developed in the United Kingdom by Spector and colleagues, Cognitive Stimulation Therapy (CST) is a non-pharmacologic psychosocial group intervention for persons with dementia. To expand upon and fill the gaps within existing research, the authors developed a descriptive study to assess the impact of CST on cognition, quality of life, and depression, among six CST groups (n = 40). A paired sample t-test was run among pre- and post-test measures. There was a statistically significant difference in Saint Louis University Mental Status Exam (SLUMS) scores after CST (t = 2.80, p = 0.008). There was also a statistically significant difference in Cornell Scale for Depression in Dementia scores (t = -3.36, p = 0.002). There was no statistically significant difference in Quality of Life scores.

The assessment of fidelity in a motor speech-treatment approach.

OBJECTIVE: To demonstrate the application of the constructs of treatment fidelity for research and clinical practice for motor speech disorders, using the Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT) Fidelity Measure (PFM). Treatment fidelity refers to a set of procedures used to monitor and improve the validity and reliability of behavioral intervention. While the concept of treatment fidelity has been emphasized in medical and allied health sciences, documentation of procedures for the systematic evaluation of treatment fidelity in Speech-Language Pathology is sparse. METHODS: The development and iterative process to improve the PFM, is discussed. Further, the PFM is evaluated against recommended measurement strategies documented in the literature. This includes evaluating the appropriateness of goals and objectives; and the training of speech-language pathologists, using direct and indirect procedures. Three expert raters scored the PFM to examine inter-rater reliability. RESULTS: Three raters, blinded to each other's scores, completed fidelity ratings on three separate occasions. Inter-rater reliability, using Krippendorff's Alpha, was >80% for the PFM on the final scoring occasion. This indicates strong inter-rater reliability. CONCLUSION: The development of fidelity measures for the training of service providers and treatment delivery is important in specialized treatment approaches where certain 'active ingredients' (e.g. specific treatment targets and therapeutic techniques) must be present in order for treatment to be effective. The PFM reflects evidence-based practice by integrating treatment delivery and clinical skill as a single quantifiable metric. PFM enables researchers and clinicians to objectively measure treatment outcomes within the PROMPT approach.

Treating speech subsystems in childhood apraxia of speech with tactual input: the PROMPT approach.

PURPOSE: Prompts for Restructuring Oral Muscular Phonetic Targets (PROMPT; Hayden, 2004; Hayden, Eigen, Walker, & Olsen, 2010)-a treatment approach for the improvement of speech sound disorders in children-uses tactile-kinesthetic- proprioceptive (TKP) cues to support and shape movements of the oral articulators. No research to date has systematically examined the efficacy of PROMPT for children with childhood apraxia of speech (CAS). METHOD: Four children (ages 3;6 [years;months] to 4;8), all meeting the American Speech-Language-Hearing Association (2007) criteria for CAS, were treated using PROMPT. All children received 8 weeks of 2 × per week treatment, including at least 4 weeks of full PROMPT treatment that included TKP cues. During the first 4 weeks, 2 of the 4 children received treatment that included all PROMPT components except TKP cues. This design permitted both between-subjects and within-subjects comparisons to evaluate the effect of TKP cues. Gains in treatment were measured by standardized tests and by criterion-referenced measures based on the production of untreated probe words, reflecting change in speech movements and auditory perceptual accuracy. RESULTS: All 4 children made significant gains during treatment, but measures of motor speech control and untreated word probes provided evidence for more gain when TKP cues were included. CONCLUSION: PROMPT as a whole appears to be effective for treating children with CAS, and the inclusion of TKP cues appears to facilitate greater effect.

Spirituality in end-of-life care: attending the person on their journey.

Spirituality is a fundamental element to the human experience of health and healing, illness and dying. Spiritual care is an essential component of palliative and end-of-life care provision and is the responsibility of all staff and carers involved in the care of patients and families. As end-of-life care is a significant element of community nursing, this article explores the relevancy of spirituality to end-of-life practice, the challenge of defining spirituality and the attributes and skills required for the practice of spiritual care. The aim of is to encourage self reflection and open dialogue about the subject, thus enhancing community nurses' understanding of spiritual care practice. By reflecting and generating talk about the practice of spiritual care, it may become more normalized, recognized, and practically meaningful, thereby retaining its significance in holistic nursing.

Perceptual and Articulatory Changes in Speech Production Following PROMPT Treatment.

PROMPT (Prompts for Restructuring Oral Muscular Phonetic Targets) is a treatment approach that is widely used to improve sound production in children with speech impairments. This approach uses tactile cues to support and shape movements of the oral articulators in order to improve the production of individual sounds, syllables, words, and eventually connected speech. The underlying assumption is that tactile cuing will facilitate changes in articulator movements. This investigation examined articulator movement as well as the accuracy of speech production, before, during, and after a period of PROMPT treatment in a child with severe articulation impairment. A typically developing child was followed longitudinally as a control. The following research questions were addressed: (1) Does speech sound accuracy improve over an eight-week course of PROMPT treatment? (2) Does articulator movement (duration, displacement, velocity) change over an eight-week course of PROMPT treatment? The results revealed increased articulation accuracy and decreased movement duration, displacement, and velocity over the course of PROMPT treatment in the child with the articulation impairment. By the last treatment session, kinematic findings were most similar to those seen in the control. These results suggest that PROMPT facilitated changes in articulatory control in a single participant.

Teaching young nonverbal children with autism useful speech: a pilot study of the Denver Model and PROMPT interventions.

This single subject design study examined two models of intervention: Denver Model (which merges behavioral, developmental, and relationship-oriented intervention), and PROMPT (a neuro-developmental approach for speech production disorders). Ten young, nonverbal children with autism were matched in pairs and randomized to treatment. They received 12 1-h weekly sessions of therapy and daily 1-h home intervention delivered by parents. Fidelity criteria were maintained throughout. Eight of the ten children used five or more novel, functional words spontaneously and spoke multiple times per hour by the conclusion of treatment. There were no differences in acquired language skills by intervention group. Initial characteristics of the best responders were mild to moderate symptoms of autism, better motor imitation skills, and emerging joint attention skills.